- Network Discounts and Renewals
- Pharmacy Benefits
- Marketplace Solutions and Innovations
- Stop Loss Coverage
- Projections, Plan Mergers, and Withdrawals
- We have a deep understanding of carriers and business models in the marketplace, including fully insured plans, self-insured plans, and hybrid plans
- We leverage this knowledge to secure aggressive renewals and/or issue competitive requests for proposals (RFPs) to the marketplace. We are successful at negotiating multi-year fees, often with rate caps or not-to-exceed guarantees
- Benchmarking and relevant comparisons
- We help clients assess member impact (e.g., will members gain or lose access to provider or prescription drug?) and support implementation to make sure there are no surprises for trustees or members
- Is a traditional or transparent pharmacy benefit management model (PBM) the best fit for my plan?
- Should my plan carve-in or carve-out prescription drug coverage?
- Are there alternative funding arrangements for very high-cost drugs and/or gene therapies?
- Do group purchasing coalitions make sense for my plan?
- Searching for solutions that address specific problems and pain points
- Evaluating care management such as telemedicine and musculoskeletal (MSK) health
- Analyzing potential costs and impacts
- Negotiating favorable cost, terms, and conditions
- Coordinating fund professionals and vendor service providers to meet compliance deadlines
- Working with fund professionals to ensure common understanding of rules and regulations
- Identifying service provider capabilities to meet requirements
- Apprising plan sponsors of options and alternatives
- Keeping clients and fund professionals updated by monitoring legislative and compliance issues
- Whether stop loss coverage includes/excludes very expensive new gene therapies
- Reducing cost-shifting to the fund through the use of lasers
- Ensuring that stop loss coverage ‘mirrors’ current plan design, as much as possible
- Access to Centers of Excellence when available
- Financial reporting
- Claims Experience and Expected Trend
- Impact of withdrawal on reserves, hours bank, and IBNP
- Potential risk charges/loads to build reserves for groups merging in
- Savings opportunities or stronger purchasing power through efficiencies/reducing redundancies
Time to review your Pharmacy Benefit Manager (PBM) contract?
We can benchmark your current agreement, help you negotiate a favorable deal, introduce lower cost opportunities for expensive medications, and audit your PBM to make sure they are complying with all contract terms.
Time to review your Pharmacy Benefit Manager (PBM) contract?
The Rael & Letson healthcare practice has specialized expertise in the pharmacy benefit management (PBM) space and can deliver solutions for your self-funded prescription drug benefit program. Such services include:
- Claims review of detailed data and monthly tracking of performance;
- Review of PBM reporting and discussion of tailored clinical programs;
- PBM RFP solicitation and review of results, including contract review of the new selected PBM and assistance in the implementation process;
- Financial audits performed at the end of each contract year to ensure PBMs have met their financial guarantees; and
- Overall support in the event questions or issues arise related to the prescription benefit plan or dealings with the PBM.
Let us know how we can help.
Retiree benefit costs and options a concern?
Talk to us about ideas to control retiree medical costs while enhancing choice for your retirees, including an RDS audit to recover Medicare subsidy dollars, or an Employer Group Waiver Plan (EGWP) that can offer additional savings.
Retiree costs continue to be an ongoing concern for most trust funds as subsidy levels have grown over time. We can assist in evaluating the retiree population of your health plan to determine whether a private exchange is a viable option for your Medicare retirees. We also have relationships with Medicare Part D vendors that can conduct a RDS audit to identify Part D overpayments and recoveries. If a RDS approach is not producing the results desired, we can identify whether an EGWP approach is a more suitable solution and advise you of the pros and cons of using such an approach.
Need help in implementing a consumer directed health plan that meets your objectives?
If you are considering implementing a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA), we can provide you with options that address your specific concerns, such as developing the appropriate plan design, searching for the right vendor, and preparing the plan document.
Consumer directed health plans have become dynamic vehicles that allow participants to have more control over their health care spending needs. By diverting employer contributions to a Health Reimbursement Account (HRA), trust funds can lower the cost of medical and prescription drug plans by re-designing benefits, or by eliminating retiree subsidies and giving active participants the opportunity to save for retiree medical coverage. Recent regulatory changes related to Health Reimbursement Arrangement Accounts (HRA) may significantly increase the use of HRA’s. We can assist in all phases of a HRA or HSA implementation for your active and retiree participants.
Interested in Primary Care delivery alternatives?
Off/Near site clinics, create interesting opportunities to provide a more robust primary care experience and lower overall health care costs. Ask us about the opportunities and challenges associated with this alternative.
Shortages of local contracted primary care physicians and other related services have presented challenges for some health plans. Other plans desire a more customized approach in delivering primary care to their participants. In either situation, we can assist in exploring opportunities to establish an exclusive clinic for your participants, or partner with an already fully established clinic.
Provider price and quality transparency an issue?
Yes it is. Let’s talk about ways to equip your members and employees with the tools they need to be educated healthcare consumers.
Finding the right physician, specialist, outpatient facility or hospital to perform the quality medical care required has been a struggle for most participants of a health plan. We can assist in finding vendors who specialize in transparency tools that allow participants to select professionals or facilities that achieve the best medical outcomes for a particular procedure with the lowest out-of-pocket exposure.
Is your Telemedicine benefit working?
Talk to us about your experiences and/or interest in adopting a program.
Video and audio access to a physician who can diagnose your minor illness or injury on a 24/7 basis has become a prominent feature among health plans. The problem lies in generating awareness and participation in a telemedicine program to produce meaningful results. We can assist in finding the right telemedicine vendor for your plan and in developing a promotional campaign to achieve high utilization and ultimately lower costs.
What are your top health plan issues?
Looking to run it by someone? What are you and your co-workers, fellow Trustees and plan professionals seeing, doing, or concerned about?
Retiree Health Plans 101
Senior Consultant Wesley Yoder discusses the rules and challenges that plan sponsors face when introducing and managing existing retiree health and welfare plans.Click here for the article featured in Benefits Magazine.
We understand your plans.®